Shankar P R
KIST Medical College, Imadol, Lalitpur, Nepal.
Rural Remote Health. 2010 Jul-Sep;10(3):1420. Epub 2010 Sep 14.
In Nepal, a number of private sector medical schools have opened recently; although sufficient numbers of doctors are graduating there continues to be a doctor shortage in rural areas. This article analysed the rural doctor shortage in Nepal and reviewed the international literature for strategies that may be suitable for use in Nepal.
Original research articles, reviews, magazine articles and project reports dealing with Nepal and other developing countries during the period 1995 to 2010 were sourced via Google, Google Scholar and Pubmed. Full text access was obtained via WHO's HINARI database.
The health workforce in Nepal is unevenly distributed resulting in doctor shortages in rural areas. The recent introduction of mandatory rural service for scholarship students was aimed to reduce the loss of medical graduates to developed nations. High tuition fees in private medical schools and low Government wages prevent recent graduates from taking up rural positions, and those who do face many challenges. Potential corrective strategies include community-based medical education, selecting rural-background medical students, and providing a partial or complete tuition fee waiver for medical students who commit to rural service. Traditional healers and paramedical staff can also be trained for and authorized to provide rural health care.
A range of strategies developed elsewhere could be used in Nepal, especially community-oriented medical education that involves rural doctors in training medical students. The reimbursement of tuition fees, assistance with relocation, and provision of opportunities for academic and professional advancement for rural doctors should also be considered. Government investment in improving working conditions in rural Nepal would assist rural communities to attract and retain doctors.
在尼泊尔，近期有许多私立医学院校开办；尽管有足够数量的医生毕业，但农村地区仍存在医生短缺的情况。本文分析了尼泊尔农村地区医生短缺的问题，并查阅了国际文献，以寻找可能适用于尼泊尔的策略。
通过谷歌、谷歌学术和PubMed搜索了1995年至2010年期间涉及尼泊尔和其他发展中国家的原创研究文章、综述、杂志文章和项目报告。通过世界卫生组织的HINARI数据库获取全文。
尼泊尔的卫生人力分布不均衡，导致农村地区医生短缺。最近对享受奖学金的学生实行强制农村服务，旨在减少医学毕业生流向发达国家的损失。私立医学院校的高学费和政府的低工资，使得刚毕业的学生不愿到农村就职，而那些到农村工作的人则面临诸多挑战。潜在的纠正策略包括开展基于社区的医学教育、选拔农村背景的医学生，以及为承诺到农村服务的医学生提供部分或全部学费减免。还可以对传统治疗师和辅助医务人员进行培训并授权他们提供农村医疗服务。
其他地方制定的一系列策略可在尼泊尔使用，特别是让农村医生参与医学生培训的面向社区的医学教育。还应考虑报销学费、提供搬迁援助，以及为农村医生提供学术和职业发展机会。政府加大对改善尼泊尔农村工作条件的投资，将有助于农村社区吸引和留住医生。
